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BioMed Research International
Volume 2013, Article ID 640265, 9 pages
Research Article

Joint Involvement in Primary Sjögren’s Syndrome: An Ultrasound “Target Area Approach to Arthritis”

1Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
2Department of Musculoskeletal Ultrasonography, Instituto Nacional de Rehabilitación, Avenue México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389 Mexico City, Mexico
3Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
4Department of Rheumatology, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan, 4800, Sección XVI, Tlalpan, 14080 Mexico City, Mexico
5Department of Rheumatology, Hospital Nacional Rosales and Instituto Salvadoreño del Seguro Social, Final calle Arce 25 Avenue Norte, San Salvador, El Salvador
6Department of Dermatology, Hospital General de Zona 1-A Dr. Rodolfo Antonio de Mucha Macías, Instituto Mexicano del Seguro Social, Municipio Libre 270, Portales Sur, Benito Juarez, 03300 Mexico City, Mexico
7Clinica Reumatologica, Università Politecnica delle Marche, Via dei Colli 52, Jesi, 60035 Ancona, Italy

Received 11 April 2013; Revised 14 June 2013; Accepted 14 June 2013

Academic Editor: Michael Mahler

Copyright © 2013 Luis M. Amezcua-Guerra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren’s syndrome (pSS). Methods. Seventeen patients with pSS, 18 with secondary Sjögren’s syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed. Results. In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% specificity for diagnosing sSS; in comparison, these figures were 72.2 and 94.1% for circulating anti-CCP antibodies. Conclusions. In pSS, the pattern of joint involvement by US is polyarticular, bilateral, and symmetrical. Synovitis is the US sign most commonly found in patients with pSS, especially in MCP joints, wrists, and knees, and bone erosions also may occur.